Provider Demographics
NPI:1790726503
Name:TENNESSEE STATE VETERANS HOME BOARD
Entity Type:Organization
Organization Name:TENNESSEE STATE VETERANS HOME BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-225-1816
Mailing Address - Street 1:PO BOX 11328
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129
Mailing Address - Country:US
Mailing Address - Phone:615-225-1816
Mailing Address - Fax:615-898-1181
Practice Address - Street 1:ONE VETERANS WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-3101
Practice Address - Country:US
Practice Address - Phone:865-862-8100
Practice Address - Fax:865-690-5981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445484Medicaid
TN445484Medicare Oscar/Certification